Summary: Mr B says the Council’s assessments of his needs contained inaccuracies and the Council failed to support him. We have not found inaccuracies in the assessments but the Council should have communicated its conclusions better in earlier assessments. As all the assessments came to the same conclusion, this has not affected the outcome.

The complaint

1. Mr B and Ms C complain about the assessments of Mr B’s needs for care and support. They say the assessments are full of inaccuracies and Mr B is not receiving the support that he needs. They also say the social worker has made statements which have caused Mr B distress.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether an organisation’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
3. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

4. I have discussed the complaint with Mr B and Ms C. I have considered the documents they and the Council have sent, the relevant law, guidance and policies and both sides’ comments on the draft decision.

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What I found

Law, guidance and policies

5. The Care Act 2014 and the Care and Support Statutory Guidance 2014 (updated 2017) set out the Council’s duties towards adults who require care and support and its powers to charge. The Council also has its own policies.

Assessment and care plan

6. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs

Eligible needs

7. The threshold for eligibility is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. Councils must consider whether:
• The adult’s needs arise from a physical or mental impairment or illness.
• As a result of the adult’s needs the adult is unable to achieve 2 or more of the specified outcomes.
• As a consequence of being unable to achieve these outcomes there is a significant impact on the adult’s wellbeing.

Outcomes

8. The outcomes are:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Being able to make use of the home safely
• Maintaining a habitable home environment
• Developing and maintaining family or other personal relationships
• Accessing and engaging in work, training, education or
• Making use of necessary facilities or services in the local community
• Carrying out caring responsibilities for a child

Needs met by a carer

9. In considering the needs of the adult needing care, the local authority must take into consideration any needs that are being met by a carer. Provided the carer remains willing and able to continue caring, the local authority is not required to meet those needs. However, the local authority should record the carer’s willingness to provide care and the extent of this in the plan of the person and also the carer, so that the authority is able to respond to any changes in circumstances.

What happened

10. Mr B has a brain injury and has physical and mental health disabilities. Mr B lived with his partner, Ms C in a flat rented from the Council.

Needs assessment – January 2020

11. The Council assessed Mr B in January 2020. The social worker said Mr B relied on his partner for support with some activities of daily living. He was independent in personal care, getting dressed and nutrition. In terms of social inclusion, the social worker said Mr B was lonely and was not receiving mental health support. Mr B said he did not drive as he often got lost.
12. The social worker said Mr B was not eligible for care and support from the Council.

Complaint – February 2020

13. Mr B complained to the Council on 18 February 2020 and said the assessment was missing information and contained inaccuracies. He said this had delayed the provision of support and he wanted compensation for the ‘pain and suffering experienced because of the neglect’.

Needs assessment – February 2020

14. The Council re-assessed Mr B on 25 February 2020 and added further information to the assessment. The social worker said Mr B needed prompting for personal care and nutrition. Mr B had said he sometimes drove but occasionally got lost or would forget his destination.
15. The social worker added that Mr B said the windows in his property were not correctly sealed and this resulted in a draft. He said this had an impact on his physical health as he was not able to regulate his temperature.
16. The conclusion of the assessment was the same but the Council said Mr B may benefit from an occupational therapist’s assessment.

Complaint – March 2020

17. The Council responded to Mr B’s complaint and said it had provided a fresh assessment and had updated this assessment with the information that Mr B provided.

Occupational therapist’s assessment – March 2020

18. Following the occupational therapist’s assessment on 19 March 2020, Mr B was provided with a padded toilet seat and a bath lift.

Needs assessment – June 2020

19. Mr B contacted the Council on 10 June 2020 and said he was isolated and lonely and would like to attend a group or club offering support. He said he had requested support before but had not received any support.
20. The Council re-assessed Mr B. The social worker noted that Mr B and Ms C were expecting their first child. Mr B said children were not allowed under their tenancy agreement so they were waiting to move.
21. The social worker said:
• Mr B had eligible needs but they were met by Ms C. Ms C prepared meals, did the shopping, assisted Mr B to wash his hair and reassured him when he was forgetful.
• Mr B developed ‘hypersensitivity to sudden drops in temperature which impacts on his balance… A simple draft in the flat can trigger a falling or fainting episode.’
• Mr B is ‘in a dilemma as the current flat has finally been draft-proofed he is dreading moving to a new property where his fainting episodes may start all over again due to the sudden changes in temperature caused by drafts.’
• Mr B said he wanted to attend a supportive group that helped vulnerable people and the social worker said she would provide him with some information about this.
22. The social worker made it clear that Mr B had eligible needs and listed the outcomes that Mr B was unable to achieve without support from his main carer, Ms C. The conclusion was that Mr B was not eligible for a support service as Ms C was providing the support.

Complaint – July 2020

23. Mr B complained on 16 July 2020 and said:
• He made a complaint in January 2020 and had had no contact about this complaint.
• Another assessment had been carried out and ‘yet again much information is missing or inaccurate.’
• This had caused him a lot of distress and anxiety.

Council’s response – August 2020

24. The Council responded and said:
• Three assessments of needs had been carried out since January 2020. These all concluded that Mr B was not eligible for a service by the Council, but he had received support from the occupational therapist.

November 2020 – December 2020

25. The Council placed Mr B and Ms C’s child on a child protection plan following concerns about Mr B’s mental health and his behaviour. It was decided at the child protection conference that the Council would re-assess Mr B’s needs for support.

Assessment of need – February/March 2021

26. The council re-assessed Mr B’s needs in February 2021.
• The social worker noted that Mr B had said that the previous assessments were full of inaccuracies. The social worker therefore emailed Mr B a copy of the previous assessment in advance of the assessment. Mr B wrote his amendments on the assessment and took photos of the amended assessment.
• The February 2021 assessment was more detailed than before. The social worker added Mr B’s comments in brackets.
• Mr B said he continued to experience drafts and cold spots in the flat and he was dreading moving to a new property where his fainting episodes may occur again due to sudden changes in temperature caused by drafts.
• The family had been allocated a two-bedroom property and were due to move in a few weeks’ time.
27. The social worker concluded by listing Mr B’s eligible needs and said these were met by Ms C. Mr B therefore did not require a service from the Council.

Ms C’s complaint – March 2021

28. Ms C complained to the Council because she said the social worker had implied, during her assessment, that seizures were synonymous with persons living with head injuries.
29. The social worker’s manager responded and said the social worker wished to apologise for any confusion or misunderstanding that may have occurred during the assessment process. The social worker also said they were not medically trained to make a clinical judgment and would therefore not intentionally offer one.

Complaint – August 2021

30. Mr B made a further complaint in August 2021 and said:
• Assessments took too long to complete and were inaccurate.
• He had been waiting for support for 20 years and had not received it.
• The social worker had ‘tortured’ him in front of his family by the statements she made and he had recordings of this.
31. The Council said:
• There was no delay in the assessments and the assessments were accurate. If Mr B could say what part of the assessment he disagreed with, he should do so.
• The Council’s adult social care involvement with Mr B had started in 2016 and Mr B had not said what support he felt the Council should be providing.
• Mr B had not provided any details about the ‘torture’ by the social worker so the Council could not comment.

Complaint to the Ombudsman

32. Mr B came to the Ombudsman with his complaint. I spoke to Mr B and Ms C about their complaint as it was difficult to determine what their complaint was because the complaint was often framed in general terms.
33. I asked Mr B what he meant by the social worker’s ‘torture’. He said the social worker told him that, because of his brain injury, he should expect to have falls or epileptic fits. He said that this was very upsetting to him as he knew the drafts were the cause of the problems he was experiencing. When I spoke to Ms C, she explained that they were worried that the social worker’s statement would affect their housing situation.
34. Mr B also said the social worker told him that all he wanted from social services was support for a personal independence payment. He said that was not true.
35. I asked Mr B and Ms C what adult social care support the Council should have provided. They said there should have been better cooperation between all agencies to assist them. They should have been rehoused sooner. They felt that children social services’ involvement was totally unnecessary and that the adult social care team contributed to this.
36. Mr B and Ms C have made complaints about the other agencies’ (health services, children social services and housing) involvement. The complaints about health services and housing disrepair are outside of the Ombudsman’s jurisdiction and the complaint about children social services is still going through the Council’s complaints process. The complaint I am investigating relates to the involvement of the adult social care team only.

Council’s comments

37. The Council made the following comments to the Ombudsman:
• The social worker made a referral to the local CAB agency to assist Mr B in applying for benefits including PIP. The social worker did not say that all Mr B wanted was PIP.
• The social worker did not recall saying that Mr B experienced falls and fits because of his brain injury, rather than the drafts. She acknowledged that she had asked Mr B questions to seek clarity about triggers and symptoms and the Council apologised for any misunderstanding and distress this may have caused Mr B.

Analysis

38. The Council admits that, during the assessment discussions, there may have been a misunderstanding about the social worker’s view on the causes of Mr B’s falls and fits. The Council has apologised for this.
39. I cannot add anything further to this. I note that in all the assessments the social worker has said that Mr B says the fits and falls are caused by the drafts. I also agree with the Council that the question whether the drafts caused the falls or fits was not something the social worker could decide as this could only be determined by a medical professional.
40. I note the social worker referred Mr B for support in his benefits application, but denies saying that PIP was all Mr B wanted. In the absence of any other evidence I cannot say there was fault.
41. I have also considered Mr B’s complaint about the assessments. I note good practice in that, when Mr B complained about the first assessment in January 2020, the Council immediately agreed to re-assess him, resulting in the February 2020 assessment.
42. I note that each assessment has more detail than the previous one. The conclusion of the first two assessments is that Mr B is ‘not eligible’. It is not entirely clear from the assessments whether this means that Mr B has no eligible needs or that he has eligible needs, but they are met by Ms C. The Council should have made this clearer.
43. The two most recent assessments are clear in explaining what Mr B’s eligible needs are and in stating that Ms C is meeting these needs which is why Mr B does not qualify for a service from the Council.
44. I note that the conclusion in all four assessments was the same so Mr B has not suffered an injustice as a result of the lack of clarity in the initial assessments.
45. I have also considered the complaint that there were inaccuracies in the assessments. I have considered the changes in the assessments and, in particular, the amendments made by Mr B in the fourth assessment. The amendments that Mr B included were not corrections of wrong facts, but Mr B added more information, clarification or his opinions. Therefore, I do not uphold the complaint that the earlier assessments contained inaccuracies or that these would have affected the conclusions.

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Final decision

46. I have completed my investigation. I have concluded that, although the communication in the earlier reports could have been clearer, this did not affect the outcome.

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Investigator's decision on behalf of the Ombudsman